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Whole study guide Flashcards

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1
Q

What seven potentially reversible causes of hypertension should be identified first before administering beta blockers?

A

Pain, hyperthermia, anxiety, increased ICP, bladder distention, poorly controlled HTN, and lack of anesthesia.

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2
Q

What are the three primary physiological effects of beta blockers on the heart?

A

Decreased heart rate, decreased AV node conduction, and decreased cardiac contractility (CO).

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3
Q

Which beta blocker causes significant vasodilation due to alpha 1 receptor blockade?

A

Labetalol.

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4
Q

Why are non-selective beta blockers like Propranolol and Labetalol contraindicated in asthmatics?

A

They can cause bronchospasm.

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5
Q

Beta blockers can mask the symptoms of which metabolic condition?

A

Hypoglycemia.

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6
Q

Which receptors does Labetalol antagonize?

A

Nonselective beta 1, beta 2, and selective alpha 1.

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7
Q

What is the primary mechanism of elimination for Esmolol?

A

Metabolism by plasma esterases.

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8
Q

Esmolol is contraindicated in which cardiac conditions? (4)

A

Bradycardia, heart block, cardiogenic shock, and heart failure.

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9
Q

Which nonselective beta blocker is used specifically for pheochromocytoma, anxiety, and panic attacks?

A

Propranolol.

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10
Q

Which selective beta 1 blocker is a common treatment for myocardial infarction (MI)?

A

Metoprolol.

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11
Q

What is the underlying neurotransmitter imbalance in anticholinergic poisoning?

A

Too little acetylcholine (ACh).

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12
Q

List the five components of the anticholinergic toxicity mnemonic.

A

Mad as a hatter, dry as a bone, red as a beet, hot as a hare, blind as a bat.

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13
Q

Which symptoms characterize ‘Mild’ anticholinergic toxicity? (5)

A

Tachycardia, flushed face, mydriasis/blurred vision, dry mouth/skin, and fever.

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14
Q

Which symptoms characterize ‘Moderate’ anticholinergic toxicity? (4)

A

Agitated delirium, urinary retention, hypertension, and hyperthermia.

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15
Q

What are the cardiovascular signs of ‘Severe’ anticholinergic toxicity? (3)

A

QRS widening, increased QT interval, and circulatory collapse/hypotension.

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16
Q

Name two medications used to treat anticholinergic toxicity.

A

Benzodiazepines and Physostigmine.

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17
Q

What specific property of Physostigmine allows it to treat central anticholinergic symptoms?

A

It is a tertiary amine that crosses the blood-brain barrier (BBB).

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18
Q

Fentanyl: Side effect of mu1 receptor stimulation on heart rate?

A

Bradycardia.

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19
Q

Fentanyl: Side effect of mu2 receptor stimulation on respiration?

A

Respiratory depression.

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20
Q

Fentanyl: Which receptor is responsible for miosis?

A

Kappa receptor.

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21
Q

What is ‘wooden chest syndrome’ and what causes it?

A

Skeletal muscle rigidity, often following rapid IV administration of 10-15 mcg/kg.

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22
Q

What type of neuromuscular blocking drug is Pancuronium?

A

Long-acting, non-depolarizing aminosteroid.

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23
Q

Why does Pancuronium cause modest tachycardia?

A

Antimuscarinic stimulation and inhibition of norepinephrine reuptake (vagolytic effects).

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24
Q

In what surgical context is Pancuronium often used to counteract opioid-induced bradycardia?

A

Cardiac surgery.

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25
What is the mechanism of action for Hydralazine's vasodilatory effect?
Direct systemic arterial vasodilation by blocking calcium release from the sarcoplasmic reticulum (SR).
26
Why does Hydralazine cause reflex tachycardia?
Arteriolar vasodilation leads to a decrease in SVR and BP, triggering a compensatory heart rate increase.
27
In which respiratory condition is Hydralazine preferred for treating hypertension?
Asthma (HPB asthmatics).
28
Which enzyme does Toradol (ketorolac) non-selectively inhibit?
Cyclooxygenase (COX-1 and COX-2).
29
Why is Toradol contraindicated in patients with an aspirin allergy?
Potential for cross-sensitivity and exacerbation of asthma/nasal polyps.
30
What severe condition can Methylene Blue induce in patients taking MAOIs?
Serotonin syndrome.
31
What is a common side effect shared by both Methylene Blue and Indigo Carmine regarding pulse oximetry?
They cause falsely low SpO2 readings.
32
What is the mechanism of action for Robinul (glycopyrrolate)?
Synthetic antimuscarinic and competitive ACh antagonist.
33
Why does glycopyrrolate lack CNS effects compared to atropine?
It is a quaternary ammonium that does not cross the BBB.
34
Where does Acetaminophen primarily exert its effects?
Mainly in the central nervous system (CNS).
35
What is a significant safety difference between Acetaminophen and NSAIDs regarding platelets?
Acetaminophen has no effect on platelets, whereas NSAIDs inhibit platelet aggregation.
36
What is the IV version of Acetaminophen (Ofirmev) known to contain that might necessitate a Foley catheter?
Mannitol.
37
What is the typical onset time of Succinylcholine?
1 minute.
38
What is the onset time of Rocuronium depending on the dose?
1-2 minutes.
39
Which potent arterial dilator is associated with maternal/fetal cyanide toxicity at high doses?
Nipride (Nitroprusside).
40
Why is Lidocaine administered 3 minutes before intubation? What does it reduce and attenuate?
To suppress the cough reflex and attenuate increased airway resistance/intracranial pressure.
41
What is the primary mechanism of Ketamine? What does it block?
Noncompetitive NMDA receptor antagonist that blocks glutamate.
42
What is the typical induction dose for Ketamine IV?
2-4 mg/kg.
43
Why is Ketamine relatively contraindicated in patients with elevated ICP?
It is a potent cerebral vasodilator that increases cerebral blood flow (CBF).
44
What medication is given with Ketamine to prevent emergence delirium?
Midazolam (Versed).
45
Why is Ketamine considered an ideal agent for induction in hypovolemic patients? What does it stimulate?
It stimulates the sympathetic nervous system, increasing MAP, CO, and HR.
46
What is the mechanism of action for Propofol?
GABA_A receptor agonist (enhancement of GABA inhibition).
47
List the components of the Propofol emulsion.
1% propofol, 10% soybean oil, 2.25% glycerol, and 1.2% egg phospholipid.
48
What is the typical induction dose for Propofol?
1-2.5 mg/kg (average 2 mg/kg).
49
How does Propofol affect cerebral hemodynamics?
It lowers cerebral metabolic oxygen consumption (CMRO_2) and decreases ICP by lowering CBF.
50
What is Propofol Infusion Syndrome (PRIS)?
A rare, fatal condition from high-dose infusions (>5 mg/kg/hr) characterized by organ failure, metabolic acidosis, and rhabdomyolysis.
51
What is the time limit for using Propofol once it has been drawn into a syringe?
6 hours.
52
What is the mechanism of action for Dexmedetomidine (Precedex)?
Highly selective alpha_2-adrenergic agonist.
53
How does Precedex produce sedation?
By inhibiting norepinephrine release in the locus coeruleus.
54
What cardiovascular side effects are associated with Precedex?
Hypotension and bradycardia.
55
What is the chemical structure of Succinylcholine?
Two acetylcholine (ACh) molecules joined end to end.
56
How is Succinylcholine metabolized?
Hydrolysis by butyrylcholinesterase (pseudocholinesterase) in the plasma.
57
What is a common cardiovascular side effect of Succinylcholine in children or after a second dose?
Sinus bradycardia or junctional rhythm.
58
Succinylcholine can cause a transient increase in which electrolyte?
Potassium (increases by ~0.5 mEq/dL).
59
What conditions increase the risk for severe Succinylcholine-induced hyperkalemia? (4)
Burns, severe abdominal infections, metabolic acidosis, and upregulation of extrajunctional AChR.
60
Why is Succinylcholine avoided in open eye injuries?
It increases intraocular pressure (IOP).
61
Masseter spasm after Succinylcholine administration may be an early indicator of what?
Malignant hyperthermia.
62
What is the RSI dose of Rocuronium?
1.2 mg/kg.
63
How does Sugammadex reverse neuromuscular blockade?
By encapsulating rocuronium or vecuronium molecules in the plasma.
64
What is the Sugammadex dose for a Train-of-Four (TOF) count of 2?
2 mg/kg.
65
What is the Sugammadex dose to reverse an RSI dose of Rocuronium after 3 minutes?
16 mg/kg.
66
What specific patient counseling is required after Sugammadex administration to women of childbearing age?
Hormonal contraceptives will be ineffective for 7 days.
67
Which enzyme does Etomidate inhibit, leading to adrenocortical suppression?
11beta-hydroxylase.
68
Why is Etomidate preferred for induction in hemodynamically unstable patients?
It has minimal to no effect on MAP, CO, and SVR.
69
What is a common excitatory CNS side effect of Etomidate induction?
Myoclonic movements.
70
Which non-depolarizing NMBA might precipitate if mixed with Thiopental?
Vecuronium.
71
What is the standard dose of Atropine for vagal stimulation or bradyarrhythmias?
0.2 - 0.4 mg IV.
72
How does Ephedrine increase blood pressure?
Mixed action: indirect release of norepinephrine and direct stimulation of alpha and beta receptors.
73
Why must Ephedrine be used cautiously in patients with CAD?
It increases myocardial oxygen demand by increasing heart rate and contractility.
74
What is the phenomenon of 'tachyphylaxis' associated with Ephedrine?
A rapidly decreasing response to repeated doses due to depletion of presynaptic norepinephrine.
75
What is the primary receptor target for Phenylephrine?
Selective alpha_1adrenergic receptor agonist.
76
Why does Phenylephrine cause a reflex decrease in heart rate?
Vasoconstriction increases BP, which triggers the baroreceptor reflex.
77
Which vasopressor is the 'drug of choice' in obstetrics for maintaining fetal pH?
Phenylephrine.
78
What is the V_1 receptor responsible for when Vasopressin is administered?
Cardiovascular effects (potent vasoconstriction).
79
In which condition is Vasopressin particularly useful for hypotension refractory to catecholamines?
Hypotension secondary to ACE inhibitors.
80
What is the mechanism of Hemabate (Carboprost)? What does it stimulate?
Synthetic analogue of prostaglandin F2 that stimulates uterine contractions.
81
What are two notable non-uterine side effects of Hemabate?
Airway constriction (wheezing) and increased body temperature.
82
Which beta blocker is specifically metabolized by plasma esterases, giving it a short duration?
Esmolol.
83
Potent arterial dilators (4)
Nipride Labetalol Hydralazine Nicardipine
84
Labetalol receptors
Nonselective B1 B2 Selective A1
85
Esmolol receptors
Selective B1
86
Propanolol receptors
Nonselective B1 and B2
87
Metoprolol receptors
Selective B1
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